PB2585: IS THROMBOCYTOPENIA WITH INCREASED IMMATURE PLATELET FRACTION [IPF] IN ICU PATIENTS,A BAD PROGNOSIS?
Authors: Enna Maria Lourenco, Mr Amit Jakhi, Mr Thomas Nirmal, Mr Anurag Pandey, Dr Antia Vp
Journal: HemaSphere (2023)

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background:Introduction: Thrombocytopenia appears in the background of a multisystem disorder.It is classified as: 1. The failure of the bone marrow to produce adequate numbers of platelets. 2. Increased peripheral destruction or sequestration of platelets. Thrombocytopenia can be: • Due to decreased platelet production [Acquired] • Immune mediated thrombocytopenia • Non immune mediated thrombocytopenia. Thrombocytopenia reflects the severity of dysfunction in blood-clotting systems. In the evaluation of thrombocytopenia, quantification of immature platelets can be used as index of bone marrow thrombopoietic activity. Immature platelet fraction [IPF] reflect the rate of thrombopoiesis.This reticulated platelets contains mRNA & are the youngest forms and functionally & metabolically active than the resting ones.They express more glycoprotein Ib&IIb/IIIa receptors Aims: As care pathways are different in each case of thrombocytopenia, our aim was to evaluate IPF Parameter in cases of Thrombocytopenia in ICU Patients who had positive Sofa Score. Inclusion criteria: Patients older than 18 years with different underlying diseases were included in this study Exclusion criteria were age younger than 18 years;, history of chemotherapy,liver cirrhosis or failure, of hematologic disorders, including platelet disorders; and therapeutic anticoagulation or blood transfusion Methods: The study was done at tertiary hospital in Mumbai; India.150 Patients were screened with different history of thrombocytopenia admitted from Jan 2019 to Dec2022 in the ICU. Blood collected in K2EDTA [B.D.vacutainers]. Lab.temperature maintained was ambient [20-26°c}. Samples were tested within 4 hrs of draw time. Immature platelet fraction [IPF] was identified by flow cytometry technique & enumerated the use of a nucleic acid specific dye Oxazine [fluorescent dyes] in PLT-F Channel of sysmex Results:Results: 150 samples were analysed - Patients with underlying disease PLT F [Mean} IPF % NORMAL [n=50] 33.33 % 295 4.5 % Blood stream infection, [n=19] 12.66 % 65 26.1 % CHF [n=10] 6.66 % 28 9.7% CVD [n= 7} 4.66 % 29 21% Pulmonary infection [[n=19} 12.66 % 21.6 15.5% Urinary tract infection, [n=9] 6 % 19.3 18% Abdominal infection [n=6] 4% 35.0 12.8% COPD [n=11] 7.33 % 38 23% CKD [n=10} 6.66% 41 28% Hemophagocytic lymphohistiocytosis (HLH), the mainly malignancies [n=2} 1.3% 9 32% Other [n=7] 4.66 % 28 10.9% IPF is reported as % of the total platelet count [% IPF] Our normal range of IPF is 0.8 – 6.5 % [15Male/10 Female ratio] Other tests like Prothrombin with INR, Serum Fibrinogen, D-Dimer, IL6 was elevated in these patients and in normal patients these tests were normal. Summary/Conclusion:. IPF can be useful test in the initial evaluation of patients with thrombocytopenia. Turnaround time is rapid and available with the CBC Percentage IPF reflects the balance between platelet production (increase in immature platelet count) and platelet consumption [decrease in total platelet count]. IPF elevation in the acute phase of sepsis was mainly coagulopathy-related platelet consumption resulting from platelet activation, adhesion to other immune cells, or thrombus formation rather than increased thrombopoiesis. Key Message: As a simple and readily available cellular marker, IPF could be a useful tool for illuminating the underlying pathophysiologic mechanisms of thrombocytopenia in sepsis, and identifying patients with impending septic coagulopathy and poor prognosis in routine clinical scenario. Keywords: Platelet count, Sepsis, Thrombocytopenia